Non-treatment of children with community health worker-diagnosed fast-breathing pneumonia in rural Malawi: exploratory subanalysis of a prospective cohort study

BACKGROUND: Despite recent progress, pneumonia remains the largest infectious killer of children globally. This paper describes outcomes of not treating community-diagnosed fast-breathing pneumonia on patient recovery. METHODS: We conducted an exploratory subanalysis of an observational prospective cohort study in Malawi. We recruited children (2-59 months) diagnosed by community health workers with fast-breathing pneumonia using WHO integrated community case management (iCCM) guidelines. Children were followed at days 5 and 14 with a clinical assessment of recovery. We conducted bivariate and multivariable logistic regression for the association between treatment of fast-breathing pneumonia and recovery, adjusting for potential confounders. RESULTS: We followed up 847 children, of whom 78 (9%) had not been given antibiotics (non-treatment). Non-treatment cases had higher baseline rates of diarrhoea, non-severe hypoxaemia and fever. Non-recovery (persistence or worsening of symptoms) was 13% and 23% at day 5 in those who did receive and those who did not receive co-trimoxazole. Non-recovery, when defined as worsening of symptoms only, at day 5 was 7% in treatment and 10% in non-treatment cases. For both definitions, combined co-trimoxazole and lumefantrine-artemether (LA) treatment trended towards protection (adjusted OR (aOR) 0.28; 95% CI 0.12 to 0.68/aOR 0.29; 95% CI 0.08 to 1.01). CONCLUSION: We found that children who did not receive co-trimoxazole treatment had worse clinical outcomes; malaria co-diagnosis and treatment also play a significant role in non-recovery. Further research into non-treatment of fast-breathing pneumonia, using a pragmatic approach with consideration for malaria co-diagnosis and HIV status is needed to guide refinement of community treatment algorithms in this region

Individual differences in face identity processing

We investigated the relationships between individual differences in different aspects of face-identity processing, using the Glasgow Face Matching Test (GFMT) as a measure of unfamiliar face perception, the Cambridge Face Memory Test (CFMT) as a measure of new face learning, and the Before They Were Famous task (BTWF) as a measure of familiar face recognition. These measures were integrated into two separate studies examining the relationship between face processing and other tasks. For Study 1 we gathered participants’ subjective ratings of their own face perception abilities. In Study 2 we used additional measures of perceptual and cognitive abilities, and personality factors to place individual differences in a broader context. Performance was significantly correlated across the three face-identity tasks in both studies, suggesting some degree of commonality of underlying mechanisms. For Study 1 the participants’ self-ratings correlated poorly with performance, reaching significance only for judgements of familiar face recognition. In Study 2 there were few associations between face tasks and other measures, with task-level influences seeming to account for the small number of associations present. In general, face tasks correlated with each other, but did not show an overall relation with other perceptual, cognitive or personality tests. Our findings are consistent with the existence of a general face-perception factor, able to account for around 25% of the variance in scores. However, other relatively task-specific influences are also clearly operating

Diagnosis and Treatment of the Febrile Child

Discusses the evidence that informs current etiologies of fever, stratified by regional geography, by presenting the clinical presentation, diagnosis, and treatment of the most common diseases, with special considerations for (1) certain age groups, (2) the burden of disease for different conditions, (3) classification and treatment strategies, and (4) a review of available diagnostic tests, as well as different health systems approaches to diagnosis and treatment of the febrile child at the community and health-facility levels, the evidence base for WHO-sponsored approaches such as Integrated Management of Childhood Illness (IMCI), and Integrated Community Case Management (iCCM). Fever remains one of the most common presenting symptoms of pediatric illnesses, with fever in children under age five years signifying systemic inflammation, typically in response to a viral, bacterial, parasitic, or less commonly, a noninfectious etiology. Patients’ ages and geographic settings can help direct the appropriate diagnostic approach and treatment, if local epidemiology is well understoo